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An in-depth look at regional and national economic trends that matter to the Fifth District. Updates will be published several times a month.

Regional Matters

August 24, 2017

The Opioid Epidemic

The increase in addiction to opioids and death from opioid overdose has been widely acknowledged as a national epidemic in this country. According to the Centers for Disease Control and Prevention (CDC), overdose deaths from opioids have more than quadrupled since 1999 and overdoses involving opioids kill tens of thousands of Americans every year.

The drug use is complicated by the fact that prescription opioids continue to fuel the epidemic; overdose deaths involving prescription drugs have quadrupled since 1999, according to the CDC, and as much as half of all U.S. opioid deaths involve a prescription opioid.

In the Fifth District, too, drug overdose deaths continue to rise (see chart below). In addition, the highest rate of death due to drug overdose in 2015, the most recent state data available, was in West Virginia, where the 41.5 deaths per 100,000 people was well above the second highest rate, which was in New Hampshire (34.3 per 100,000 people).

What are Opioids?

According to the National Institute on Drug Abuse, opioids are a class of drugs that interact with opioid receptors on nerve cells in the body and the brain. In addition to reducing the intensity of pain, the euphoria that opioids produce can lead to dependence. The CDC groups opioids into four categories: natural and semi-synthetic opioid analgesics (morphine, codeine, oxycodone, hydrocodone, hydromorphone, and oxymorphone) that are often available by prescription; methadone (a synthetic opioid); synthetic opioid analgesics other than methadone (such as tramadol and fentanyl); and heroin (which is synthesized from morphine).

The graph below shows rates for drug overdose deaths involving natural and semi-synthetic opioids. In the Fifth District, although West Virginia had the highest overdose rate in the country, only North Carolina and Virginia saw statistically significant changes in rates from 2014 to 2015. (Data for the District of Columbia was not available.)

There are other opioids that are synthetically produced. Fentanyl, for example, is a synthetic opioid that is 50 times more potent than heroin and 100 times more potent than morphine. Some fentanyl is pharmaceutical and prescribed to manage acute and chronic pain associated with advanced cancer.

Non-pharmaceutical fentanyl is illicitly manufactured and is often mixed with heroin or cocaine to increase the drug’s effect. This is an increasing problem across the country. In the Fifth District, every state saw a statistically significant increase in overdose deaths related to synthetic opioid use.

The use of heroin, an illegal opioid, has also been increasing in recent years across gender, age groups, and income levels. The 2015 National Household Survey on Drug Use and Health (NSDUH) indicates that in 2015, 591,000 Americans over the age of 26 reported using heroin in the past year, although some have suggested that that number is severely underestimated and that the true level of heroin use could be two or three times higher.

Heroin is typically injected, but it is also smoked and snorted. According to the CDC, past misuse of prescription opioids is the strongest risk factor for starting heroin use, which indicates that the transition from prescription opioid non-medical use to heroin use may be part of the progression to addiction.

Increased availability, relatively low price (compared to prescription opioids), and high purity of heroin in the U.S. have also been identified as possible factors in the rising rate of heroin use. West Virginia was the only state in the Fifth District not to see a statistically significant increase in heroin use from 2014 to 2015, although it still had one of the highest rates of heroin overdose in the country (see chart below).

What are the Consequences of Opioid Use?

Of course, death from overdose is not the only risk related to opioid misuse. Other health-related consequences include neonatal abstinence syndrome due to opioid use/misuse during pregnancy, the spread of HIV and hepatitis C due to drug use via injection, and increases in other public health costs such as emergency medical services, emergency room visits, and drugs used to treat addiction.

There are also social costs to the communities exposed to drug use, and these costs continue to rise. Researchers are studying the effect of the increased use of opioids on labor market participation among prime-age adults and on the ability of employers to find workers. More employers are using increasingly sensitive drug tests to detect drug use. Finding workers who are clean of drugs has challenged employers across the Fifth District, particularly in southwest Virginia and West Virginia.

Unless otherwise noted, data and background information comes from the Centers for Disease Control and Prevention.


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Views expressed are those of the authors and do not necessarily reflect those of the Federal Reserve Bank of Richmond or the Federal Reserve System.

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